Amanda Wilde (Host): This is Maimo Med Talk. I'm your host, Amanda Wilde. Joining me today is Dr. Edward Chapnick to help us understand the role vaccines play in our health. Dr. Chapnick is Vice President and Chief Infection Prevention Officer, as well as Executive Vice Chair of the Department of Medicine at Maimonides Health. Thank you for being here, Dr. Chapnick.

Edward Chapnick, MD: And thank you, Amanda, for giving me the chance to talk about this really important subject.

Host: It really has become a hot topic. The subject of vaccines and both individual health and public health are tied up into this topic, aren't they?

Edward Chapnick, MD: Very much so, yes.

Host: In light of the measles outbreak and the fact that there are likely to be others, Dr. Chapnick, could you explain the importance of vaccines in preventing such outbreaks like the measles situation?

Edward Chapnick, MD: Well, vaccines are essential not only to prevent outbreaks, but also to deal with them once an outbreak occurs. And if we are talking specifically about measles, the vaccine for measles, which is called MMR, it stands for measles, mumps, and rubella, which are all bundled into the same vaccine, is about 97% effective at preventing getting measles. And in the few people who can be vaccinated and still might get the disease, it's much less severe in immunized people than it is in unimmunized people.

Host: Did you say 97% effective?

Edward Chapnick, MD: Yes, that's correct.

Host: Wow. So for individual prevention, that's pretty darn effective. And then, vaccines also contribute to community immunity. So, who else are we protecting by getting vaccinated?

Edward Chapnick, MD: By getting vaccinated other than ourselves, of course, we are protecting people in the community who have not been vaccinated. And many of those have not been vaccinated because they have a medical contraindication to getting the vaccine. And the most common of those are people who have conditions or are on medications that suppress their immune system. So since this vaccine is alive, but inactivated virus, people who are immunocompromised can't receive it. Also, they would not respond well to the vaccine. So, those people rely on the rest of us being immunized so they don't get the measles.

Host: Got it. And so, we're protecting those who are immunocompromised. Can you discuss the general safety of these vaccines for us? I mean, that's what's become sort of a point of contention, I think. And how are the vaccines monitored for safety?

Edward Chapnick, MD: Well, the vaccines and a vaccine like MMR that was approved in the US in 1971, so we have many, many, many years of safety data and literally millions of people who have received this vaccine, and they're monitored. First of all, before a vaccine is approved, it has to be given to many people to study the safety, and effectiveness of course.

And then, there is ongoing monitoring. There is something called VAERS, which is a system that monitors reports of side effects from a vaccine, and anyone can go on that website. It's monitored by CDC, but any member of the public can go on that VAERS website, look up what side effects have been reported. So, the process is not only very extensive, it's very transparent. And for a vaccine that's been around since 1971, we know very well that MMR vaccine is extremely effective and extremely safe.

Host: Considering this body of evidence, why do you think there are persistent myths? For example, the myth that vaccines cause autism. Why does that persist?

Edward Chapnick, MD: The myth about vaccines causing autism, just for a little background that, sort of started, when a man named Andrew Wakefield published an article, and that was in 1998 that supposedly showed a link between the MMR vaccine and autism. And not only has that article been retracted, Mr. Wakefield because he's not a doctor anymore, because his license to practice medicine was taken away, was found guilty by the British Medical Society of Ethical, Medical, and Scientific misconduct in publishing that particular paper. It turns out he was receiving money from a group of lawyers that were trying to sue the manufacturer of the vaccine.

So, the one study that supposedly showed a link was fraudulent. And there have been multiple studies since then showing absolutely zero relationship between the MMR vaccine or any other vaccine and autism. Now, the reason this has persisted, first of all, there are many, or at least some individuals in our society who are very amenable to conspiracy theories. Social media has contributed because once people start clicking on studies or on items about vaccines and autism, the social media's providers keep sending them more and more information or misinformation about this supposed link.

And also, unfortunately, there have been many people who made significant amounts of money selling books about this misinformation, giving lectures, providing this misinformation, running conferences that they charge large amounts of money for people to attend. So, there are a lot of reasons this has persisted and, in some ways even, grown in the era of social media.

Host: Do you think that's why the COVID pandemic also affected people's understanding of vaccines?

Edward Chapnick, MD: Yes, a lot of the same sources of misinformation and means of spread of misinformation, became very active during the COVID pandemic, and to the point that we saw people being admitted to the hospital, literally dying from COVID and insisting that they didn't have COVID because what they saw on social media told them COVID wasn't that bad. So, this whole industry of spread of information and misinformation resulted in many, many unnecessary, serious illnesses and deaths during the COVID pandemic.

Host: So, in your position at Maimonides, how do you effectively address misinformation about vaccines?

Edward Chapnick, MD: Well, we certainly try to do it in many ways. Providing accurate information is probably the most important one. And that starts with our employees because Maimonides has more than 7,000 employees and we are and should continue to be a source of accurate medical information. So, we make sure those of us who work here receive high quality, relevant information related to vaccines and a lot of other medical topics. And we do a lot of community outreach as well to get that good accurate information to our surrounding communities.

It is a difficult thing to do though, it's almost like a good analogy is whack-a-mole. Because as soon as one piece of misinformation gets refuted, the anti-vaccine community just comes up with another one. And it takes a lot longer to prove that a link doesn't exist than to just go on social media and say, "Oh, this vaccine causes this side effect."

Host: But as you said earlier, some people don't respond well to the vaccine and shouldn't get it? Is it fair to say that some people have had terrible responses to the vaccine, or is that not true?

Edward Chapnick, MD: There is nothing in the world that we ingest in any way that has zero side effects. One can get an allergic reaction from eating a strawberry, and certainly one can get allergic reactions to vaccines. So clearly, anyone who is allergic to a certain vaccine shouldn't receive that one or shouldn't receive any vaccine that has the same ingredients that cause their allergic reaction. But the information out there about long-term side effects of vaccines, those just don't occur. There's no such thing as a long-term side effect of a vaccine.

Host: And we kind of touched on this when we began, but what's the consequence of people not getting vaccines? What do we begin to see? I mean, I guess it's like the measles outbreak.

Edward Chapnick, MD: Right. I mean, simply put, the result of people not being immunized is getting the diseases that the vaccines prevent. I think among the most significant vaccine advocates in my life were my grandparents. And by the way, my grandparents, none of them even completed elementary school, but they saw every summer people get paralyzed and die from polio, and then all of a sudden they didn't see it anymore. Why did they not see it anymore? Well, the polio vaccine. So, people who actually saw these horrible diseases and then saw those diseases vanish tend to be the most supportive of immunizing all of us.

And to give you an idea what's happening with measles now as of April 10th this year, there have been so far reported 712 cases of measles. There have been cases reported in 25 states. Most are in Texas and New Mexico, and now there are more reported in Kansas, Ohio, and various other places. The overwhelming majority of these people are unimmunized, a very high percentage of them. And so far, two children who unfortunately their parents had decided not to immunize them have died in this current epidemic, and that is completely preventable.

Host: That must be so hard for you to see. So if you don't get vaccinated, not only will you likely get the disease, but you're also helping spread it to other people. So, that's why it's crucial to maintain high vaccination rates.

Edward Chapnick, MD: Yeah, that's correct. And vaccination rates tend to vary a lot by community. There's a lot of cultural issues around whether people get vaccinated. And so, especially people who are in a community with much higher rates of not being vaccinated or much lower rates of being vaccinated, that's where this current epidemic is primarily spreading.

And then once that starts, then it starts getting into other communities that just may have suboptimal vaccine rates. It takes a rate of about 90-95% of the population to be immunized to provide effective prevention of. Spread within those communities. And there are a lot of areas of the country where it's not at 90%. So once it gets introduced into a community, it's a very contagious virus and it doesn't take a lot for it to spread if that number of immunized people is below that 90 to 95%.

Host: Dr. Chapnick, thank you so much for all this information and mapping out the role of vaccines.

Edward Chapnick, MD: My pleasure. I'm glad to try and get as much good information out there as is possible.

Host: Dr. Edward Chapnick is Chief Infection Prevention Officer at Maimonides Health. To learn more, visit maimo.org. You can also make an appointment with one of our primary care doctors to talk vaccines at 718-283-5700. I'm Amanda Wilde. Thank you so much for joining me today on Maimo Med Talk.